Provider Demographics
NPI:1881882264
Name:CARR, JODY NOELLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:NOELLE
Last Name:CARR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18111 BROOKHURST ST STE 6100
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6728
Mailing Address - Country:US
Mailing Address - Phone:714-378-7330
Mailing Address - Fax:657-221-2327
Practice Address - Street 1:18111 BROOKHURST ST STE 6100
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6728
Practice Address - Country:US
Practice Address - Phone:714-378-7330
Practice Address - Fax:657-221-2327
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19374363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant